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Wagener N, Pumberger M, Hardt S. Impact of fixation method on femoral bone loss: a retrospective evaluation of stem loosening in first-time revision total hip arthroplasty among two hundred and fifty five patients. INTERNATIONAL ORTHOPAEDICS 2024; 48:2339-2350. [PMID: 38822836 PMCID: PMC11347471 DOI: 10.1007/s00264-024-06230-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/22/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE Implant loosening represent the most common indication for stem revision in hip revision arthroplasty. This study compares femoral bone loss and the risk of initial revisions between cemented and uncemented loosened primary stems, investigating the impact of fixation method at primary implantation on femoral bone defects. METHODS This retrospective study reviewed 255 patients who underwent their first revision for stem loosening from 2010 to 2022, receiving either cemented or uncemented stem implants. Femoral bone loss was preoperatively measured using the Paprosky classification through radiographic evaluations. Kaplan-Meier analysis estimated the survival probability of the original stem, and the hazard ratio assessed the relative risk of revision for uncemented versus cemented stems in the first postoperative year and the following two to ten years. RESULTS Cemented stems showed a higher prevalence of significant bone loss (type 3b and 4 defects: 32.39% vs. 2.72%, p < .001) compared to uncemented stems, which more commonly had type 1 and 2 defects (82.07% vs. 47.89%, p < .001). In our analysis of revision cases, primary uncemented stems demonstrated a 20% lower incidence of stem loosening in the first year post-implantation compared to cemented stems (HR 0.8; 95%-CI 0.3-2.0). However, the incidence in uncemented stems increased by 20% during the subsequent years two to ten (HR 1.2; 95%-CI 0.7-1.8). Septic loosening was more common in cemented stems (28.17% vs. 10.87% in uncemented stems, p = .001). Kaplan-Meier analysis indicated a modestly longer revision-free period for cemented stems within the first ten years post-implantation (p < .022). CONCLUSION During first-time revision, cemented stems show significantly larger femoral bone defects than uncemented stems. Septic stem loosening occurred 17.30% more in cemented stems.
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Affiliation(s)
- Nele Wagener
- Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Kayani B, Neufeld ME, Bautista M, Howard LC, Abdelmalek M, Greidanus NV, Masri BA, Garbuz DS. The Wagner Cone Stem for Atypical Femoral Anatomy in Total Hip Arthroplasty: A Report of 320 Cases with Minimum 5-Year Follow-up. J Bone Joint Surg Am 2024; 106:1461-1469. [PMID: 38815006 DOI: 10.2106/jbjs.23.00849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND The Wagner Cone Prosthesis was designed to address complex femoral deformities during total hip arthroplasty (THA), but its mid-term component survivorship and functional outcomes remain undetermined. The objectives of this study were to determine the implant survivorship, patient satisfaction, functional outcomes, osseointegration as seen radiographically, implant subsidence, and complications of THA using the Wagner Cone Prosthesis stem at intermediate-term follow-up. METHODS This study involved 302 patients with proximal femoral deformities, including developmental hip dysplasia and Legg-Calvé-Perthes disease, who underwent a total of 320 primary THAs using the Wagner Cone Prosthesis. The average age at the time of surgery was 49.4 ± 14.5 years (range, 18.8 to 85.6 years). Patient satisfaction was recorded using a self-administered questionnaire assessing satisfaction in 4 domains. The University of California at Los Angeles (UCLA) activity score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score (OHS), the Forgotten Joint Score (FJS), radiographic outcomes, and complications were recorded. The mean follow-up time was 10.1 years (range, 5.2 to 15.5 years). RESULTS Survivorship of the Wagner Cone Prosthesis was 98.7% (95% confidence interval [CI]: 97.2% to 100%) with stem revision as the end point and 95.8% (95% CI: 93.5% to 98.2%) with reoperation for any reason as the end point at 10 years postoperatively. In total, 3 stems were revised: 2 for infection and 1 for chronic hip dislocation. The median patient satisfaction score was 95 (interquartile range [IQR], 80 to 100), median UCLA score was 6 (IQR, 6 to 7), median WOMAC score was 18 (IQR, 16 to 22), median OHS was 40 (IQR, 36 to 47), and median FJS was 80 (IQR, 76 to 88) at the time of final follow-up. All Wagner Cone stems that were not revised showed radiographic evidence of osseointegration, with a mean stem subsidence of 0.9 ± 0.8 mm at the most recent follow-up. CONCLUSIONS The use of the Wagner Cone Prosthesis stem in patients with complex femoral anatomy undergoing primary THA is associated with excellent component survivorship, high levels of patient satisfaction, good functional outcomes, and reliable osseointegration with minimal stem subsidence as seen on radiographs at intermediate-term follow-up. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Babar Kayani
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael E Neufeld
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maria Bautista
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa C Howard
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammed Abdelmalek
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nelson V Greidanus
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bassam A Masri
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald S Garbuz
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Castagnini F, Pardo F, Lucchini S, Rotini M, Cavalieri B, Dalla Rosa M, Vitacca S, Di Martino A, Faldini C, Traina F. Cementless Primary Stems in Revision Hip Arthroplasty: A Narrative Review. J Clin Med 2024; 13:604. [PMID: 38276110 PMCID: PMC10816713 DOI: 10.3390/jcm13020604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Cementless primary stems in revision hip arthroplasties may be conservative options to preserve bone stock and provide adequate reconstruction of the hip biomechanics. However, there is still little evidence about indications, limitations, and outcomes. This narrative review showed that conventional standard stems were adopted in different revision settings, up to Paprosky IIIA grade bone defects. In cases of acceptable metaphyseal bone stock, when a scratch fit of at least 4 cm can be achieved, a conventional cementless stem may be an adequate solution. Mid-term clinical and radiographic outcomes and survival rates were similar to long revision stems, whereas complications, surgical time, and costs were lower among conventional stems. However, unsuitable contexts for conventional stems included canal diameters larger than 18 mm and failed revision stems with cortical weakening. Even short stems can be considered in revisions, in order to preserve bone stock and stay proximal to femoral remodeling zones and bone/cement plugs. Short stems were successfully adopted up to Paprosky IIIA bone defects, achieving mid-term survival rates not inferior to long revision stems. Ageing, osteoporosis, and intraoperative femoral fractures were the main negative prognostic factors. In very select cases, a downsizing technique (from longer to shorter stems) may be adopted to simplify the procedure and reduce complications.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Stefano Lucchini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Marco Rotini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Bruno Cavalieri
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Mattia Dalla Rosa
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Stefano Vitacca
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
| | - Alberto Di Martino
- 1 Orthopedics and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (A.D.M.); (C.F.)
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
| | - Cesare Faldini
- 1 Orthopedics and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (A.D.M.); (C.F.)
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (F.P.); (S.L.); (M.R.); (B.C.); (M.D.R.); (S.V.); (F.T.)
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
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Innocenti M, Smulders K, Andreotti M, Willems JH, Van Hellemondt G, Nijhof MW. The use of a standard-length conical tapered stem in hip revision arthroplasty to address Paprosky type I-II femoral defects: a prospective study of 87 patients. Arch Orthop Trauma Surg 2023; 143:5945-5955. [PMID: 36806987 PMCID: PMC10449674 DOI: 10.1007/s00402-023-04797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Low-grade femoral defects in revision total hip arthroplasty (rTHA) might be preferably treated with a primary implant. Almost no previous study reported the use of standard-length conical tapered (SLCT) stems in these cases. We analyzed a series of cases using a SLCT stem in rTHA with Paprosky type I-II femoral defects. The purpose of the study was to determine clinical and radiographic outcomes in this series of rTHA. MATERIALS AND METHODS We prospectively followed 87 patients undergoing a femoral component rTHA: 53 Paprosky type I and 34 type II femoral defects. Patient-reported measures (Oxford Hip Score, EQ-5D, VAS pain during rest and activity) were administered at baseline, 1 and 2 years post-operatively. Radiographic subsidence overtime was scored. Kaplan-Meier curves were used to evaluate the subsidence over time, the complication-free survival, and the implant survivorship with reoperation and stem revision as endpoints. RESULTS The mean follow-up was 72.5 (SD ± 23.9) months. All PROMs significatively improved over time. The average subsidence was 2.8 (SD ± 3.2), 3.6 (SD ± 4.4), and 4.0 (SD ± 4.9) mm at 4, 12, and 24 months respectively. 6 stems had subsidence > 10 mm. The survival without complication was 0.85 (95% CI 0.94-0.77), while the implant survival without reoperation was 0.83 (95% CI 0.95-0.72). The overall stem survival rate was 93.7% (95% CI 0.91-0.97) at 2 years. CONCLUSION The use of a SLCT stem in rTHA with Paprosky type I-II femoral defects demonstrated good survival with low subsidence rates during the first 2 years after surgery. Surgeons should consider the use of this primary prosthesis as a potential treatment during stem revision in cases with limited femoral bone loss.
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Affiliation(s)
- Matteo Innocenti
- Department of Orthopaedic Surgery, University of Florence, Florence, Italy
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Mattia Andreotti
- Department of Orthopaedic, Ospedale Riuniti Padova, Padua, Italy
| | - Jore H. Willems
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Gijs Van Hellemondt
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Marc W. Nijhof
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
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Brogren E, Abramo A, Tägil M. Bone Remodeling after Ulna Head Replacement in Distal Radioulnar Joint Arthroplasty: A Radiographic Comparison between a Partial and a Total Ulna Head Concept. J Wrist Surg 2022; 11:425-432. [PMID: 36339080 PMCID: PMC9633151 DOI: 10.1055/s-0041-1742098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/17/2021] [Indexed: 11/08/2022]
Abstract
Background Ulna head arthroplasty has become an eligible solution for injury or disease in the distal radioulnar joint. Bone resorption beneath the prosthetic head is often reported, but mechanism poorly understood. Purpose The aims were to evaluate bone remodeling and radiological instability in two conceptually different distal radioulnar joint arthroplasties: the total and the partial ulna head replacement. Patients and Methods We conducted a retrospective radiographic assessment of 51 ulna head arthroplasties; 26 Herbert ulna (total ulna head replacement) and 25 First Choice (partial ulna head replacement), to analyze periprosthetic bone resorption and radiologic instability. Intraoperative/immediate postoperative and 1-year radiographs were reviewed by two independent assessors. The radiographic follow-up averaged 13 (10-17) months. The size of the stem in relation to the diameter of the ulna (filling ratio) was measured on the intraoperative/immediate postoperative radiographs. Bone resorption beneath the collar of the prothesis was measured on the 1-year radiographs and expressed as a bone resorption index (BRI) between the length of the resorption and the length of the implant stem. Radiological stability was measured on both the preoperative and the 1-year lateral radiographs. Results The total ulna head prothesis presented with more extensive bone resorption beneath the prosthetic head than the partial ulna head prothesis at 1-year post surgery ( p <0.001). The filling ratio did not influence the 1-year bone resorption and there was no difference regarding radiological instability between the two prosthetic designs. Conclusion The pattern of bone adaptions after an ulna head prothesis may differ due to design and concept of the prosthesis.
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Affiliation(s)
- Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Antonio Abramo
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Magnus Tägil
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Wongsak S, Sa-Ngasoongsong P, Pinitkwamdee S, Thongchuea N, Prasai AB, Warinsiriruk E, Jarungvittayakon C, Jaovisidha S, Chanplakorn P. Effectiveness of prophylactic double-looped wiring in cementless Hip arthroplasty: A biomechanical study in osteoporotic bone model using impaction simulation system. Injury 2022; 53:2454-2461. [PMID: 35660012 DOI: 10.1016/j.injury.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Periprosthetic femoral fracture (PFF) is well-known complication in cementless hip arthroplasty (HA), especially in the elderly with osteoporosis. To prevent intraoperative PFFs during HA, prophylactic cerclage wiring on the calcar area during femoral broaching and implant insertion is recommended. However, biomechanical data on the benefits of cerclage wiring in osteoporotic bone during impaction are limited and controversial. This study aimed to assess the efficacy of prophylactic double-looped cerclage wiring (PDLCW) during femoral broaching in the osteoporotic bone model with an impaction simulation system. METHODS Fifteen osteoporotic femur models were prepared and allocated to three groups; control group (no cerclage), PW group (received PDLCW), and CC+PW group (prepared as having calcar crack and received PDLCW). All femurs were broached under impaction force that sequentially increased until the visible fracture or calcar crack propagation was visible. The primary outcomes were mallet impaction force (MIF-CF) and mallet velocity (MV-CF) at the time of calcar fracture. The secondary outcomes were calcar fracture pattern and subsidence during calcar fracture (S-CF). RESULTS PW group showed a significant increase in average MIF-CF, by 40.4% and 120.2% (p<0.001) compared to the control and CC+PW groups, respectively. The average MV-CF in PW group was also significantly greater, 13.1% and 64.6% (p<0.001), compared to the control and CC+PW groups, respectively. Control group revealed significantly greater incidence of complete calcar fracture (60% vs. 0% vs. 0%, p = 0.024), and the highest S-CF compared to those in the PW and CC+PW groups (10.6 ± 6.0 mm, 6.7 ± 4.4 mm, and 1.3 ± 2.0 mm, p = 0.020). CONCLUSIONS This study showed that PDLCW significantly improved hoop stress resistance by increasing the calcar fracture threshold related to mallet impaction, decreasing the risk of complete calcar fracture.
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Affiliation(s)
- Siwadol Wongsak
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Paphon Sa-Ngasoongsong
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Siwadol Pinitkwamdee
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Nutchanat Thongchuea
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand.
| | - Abigyat Babu Prasai
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand
| | - Eakkachai Warinsiriruk
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand.
| | - Chavarat Jarungvittayakon
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suphaneewan Jaovisidha
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
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